Therapies for recurrence after radiotherapy

This review evaluated the safety and efficacy of focal salvage ablative therapy for the treatment of patients with prostate cancer recurrence (return of the cancer) after radiation therapy.

Radiation therapy (RT) is often used to treat early stage prostate cancer. However, after RT, the cancer may recur, locally or in distant organs and tissues of the body. Local recurrence happens at or near the same place as the original (primary) tumor. This calls for additional therapies known as salvage therapies. Focal salvage ablative therapy includes minimally invasive procedures that deliver treatment to the recurrent tumor only, thus reducing the damage to the healthy surrounding tissues. These salvage therapy procedures include brachytherapy (or internal radiotherapy which involves the insertion of a radioactive implant into the tumor), cryotherapy (the use of extremely low temperatures to freeze and destroy the cancer), and high intensity focused ultrasound or HIFU (the application of high intensity sound waves to destroy cancer cells). This review discusses these techniques as salvage treatments for locally recurrent prostate cancer.

Several studies that reported the outcomes of focal salvage ablative therapy for locally recurrent prostate cancer were reviewed in this analysis. After focal salvage cryotherapy, 1 study with 19 patients with locally recurrent prostate cancer reported a recurrence-free survival (the percentage of patients without any signs or symptoms of a recurrence a certain time after treatment) of 89%, 79% and 79% after 1 year, 2 years and 3 years of follow-up, respectively. There were low complication rates, urinary problems being the most common side effects.

Using focal salvage HIFU, one study with 39 patients reported a recurrence-free survival of 86% at 1 year of follow-up, of 75% at 2 years and 63% at 3 years after treatment. Another study that used focal salvage brachytherapy showed that 25% of patients had biochemical failure or BF after salvage brachytherapy. A BF is a rise in prostate specific antigen or PSA (a protein made by the prostate gland that can be detected in the blood of patients with prostate cancer, which is undetectable after successful treatment) levels after treatment for prostate cancer. Side effects of salvage brachytherapy consisted in problems with bladder control and problems urinating that persisted up to 5 years after the procedure. 

In summary, this review showed that focal salvage ablative therapy techniques after radiotherapy are improving and hold promise in increasing survival rates with minimal side effects for patients with locally recurrent prostate cancer. 

All the studies reviewed in this analysis had small number of patients which may not be representative for all patients with recurrent prostate cancer. Long-term randomized comparative studies involving focal ablative treatments are required to confirm these findings.

Consult with your physician on the most appropriate treatment in your situation.